Provider First Line Business Practice Location Address:
409 N 35TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-726-1421
Provider Business Practice Location Address Fax Number:
252-726-5964
Provider Enumeration Date:
06/22/2005